Ethanol
Liverpool Hospital Emergency Department
Indications:
- Ethylene Glycol (Anti-Freeze)
- Methanol
Formulation:
- IV formulation:
- 96% to 100% Dehydrated Ethanol 5-10mL Ampoule (Must be diluted prior to administration) – dilute to 10% ethanol.
- Note: Treat ALL dehydrated ethanol IV ampoules as 100%
- Dilution: Dilute 100mL of Dehydrated Ethanol with 900mL of Glucose 5% to create 10% Ethanol in 1L IV
- PO/NG formulation:
- White spirit e.g. Vodka 40%
Dosage and Administration
- Intravenous
- Loading: 6mL/Kg IV or NG (Table 1) over 60 minutes
- Maintenance: 50-100mL /Hour IV or NG to maintain a plasma ethanol level of 22 mmol/L – 44mmol/L. Serum ethanol levels must be performed hourly to ensure steady state.
- If on dialysis the maintenance dose must be double
- Oral
- Loading: 40% vodka – 3 measures of 40mls of vodka (1.8ml/kg 43%)
- Maintenance: 40ml / hr via NGT (80ml/hr if on dialysis) to maintain ethanol level of 22-44mmol/L. (0.2-0.4ml/kg/hr)
Side Effects
- Intoxication
- Local phlebitis from IV ethanol
- Hypoglycaemia Cardiac Failure
- Heart Block
- Myocardial Necrosis (Excessive)
- Ventricular Fibrillation/ Tachycardia
- Pain
- Paraesthesia
Pit Falls
- Can be difficult to titrate to blood alcohol levels
- Dialysis will be required and planned for
- Consider supportive care of airway management given the risk of vomiting and gastroparesis
- Continue until methanol or ethylene glycol level is <6.7mmol/l or 20mg/dL